(Microsoft PowerPoint - Pr\351sDBEB.pptx)

Mme Necker, 1775
EPIDERMOLYSIS BULLOSA
DENTAL CARE
Dr Bothild Kverneland 1,2), Dr Ioana Pavlov 1,2),
Pr Arnaud Picard 1,2,3), Pr Marie-PauleVazquez 1,2,3)
Service de Chirurgie Maxillo-Faciale et Plastique
Hôpital Universitaire Necker Enfants Malades, Paris, France
2) Centre de Référence des Malformations Rares
de la Face et de la Cavité Buccale
3) Faculté de Médecine Paris-Descartes, Université Paris 5
1)
EPIDERMOLYSIS BULLOSA DENTAL CARE
WHY ?
WHEN ?
HOW ?
EPIDERMOLYSIS BULLOSA DENTAL CARE
WHY ?
EPIDERMOLYSIS BULLOSA DENTAL CARE
WHY ?
TO PREVENT AND AVOID CATASTROPHIES!
- PAIN
- INFECTIONS
- LACK OF ESTHETICS
- TREATMENT DIFFICULTIES
- COST
EPIDERMOLYSIS BULLOSA DENTAL CARE
WHY ?
ANAEROBES
AEROBES
SOCIO-ECONOMIC
DIFFICULTIES,
IMMIGRATION
YOUNG AGE
DISEASE
MICROSUBSTRAT
ORGANISMES
HOST
+ TIME
IMMUNO_
DEFICIENCY
REDUCED SALIVA FLOW,
XEROSTOMIA
SALIVARY CLEARANCE
PH
TOOTH
MORPHOLOGY
LACK OF SPACE,
DIFFICULT ORAL
HYGIENE
HARD-TISSUE
QUALITY
BAD FOOD HABITS
CARBOHYDRATES
FREQUENT
FOOD INTAKE
MIXED FOOD
LIQUID MEALS
EXISTENT CARIES?
PSYCHOLOGICAL
AND MECHANICAL
STRESS
EPIDERMOLYSIS BULLOSA DENTAL CARE
WHY ?
1976: Crawford et al: - extraction of all teeth ?
1999: Wright et al: - dental treatment is possible !
2008: Skogedal et al: - good oral health is possible !
Crawford EG, Burkes EJ Briggaman RA: Hereditary epidermolysis bullosa: oral manifestations and dental therapy, O Surg. O Med. O Pathol, 42, 490-500 (1976)
Wright JT: Oral Manifestations of Epidermolysis Bulosa in EG Clinical Epidemiologiec, and Laboratrory Advances and the Findings of the National EB Registry 236256, The John Hopkins Universidty Press Baltimore (1999°
Skogedal N, Saltnes S, Storhaug K: Recessive Dystrophic epidermolyis bullosa (RDEB) Caries preventionand preventive extractions of molars. Clinical presentation of 3
cases, 2008, Ref Type Conference Proceeding
EPIDERMOLYSIS BULLOSA DENTAL CARE
WHEN ?
-
6 months: FIRST DECIDUAL TEETH
-
3 years: TEMPORARY DENTURE COMPLETE
-
6 years: FIRST PERMANENT MOLARS, INCISORS
(mixed denture)
-
9 years: PREMOLARS, CANINES
-
12 years: SECOND PERMANENT MOLAR
(young adult denture)
MEET THE DENTAL TEAM
AS SOON AS POSSIBLE,
ADAPTED INTERVALS
EPIDERMOLYSIS BULLOSA DENTAL CARE
ORAL MANIFESTATIONS
Epidermolysis Bullosa Simplex
Junctional Epidermolysis Bullosa
Dystrophique RecessiveEpidermolysis Bullosa
EPIDERMOLYSIS BULLOSA DENTAL CARE
ORAL MANIFESTATIONS
EBS
Gingival blisters, erosions, ulcers
Gingival retractions
Hypoplastic enamel?
épiderme
EBS
derme
hypoderme
TREATMENT POSSIBILITIES:
EPIDERMOLYSIS BULLOSA DENTAL CARE
ORAL MANIFESTATIONS EBJ
Enamel defect
Retained/impacted teeth
Bullous lesions, ulcers, erosions
Gingival retractions
épiderme
derme
EBJ
hypoderme
TREATMENT POSSIBILITIES:
EPIDERMOLYSIS BULLOSA DENTAL CARE
ORAL MANIFESTATIONS dReb
Gingival blisters, erosions, ulcers
Gingival retractions
Microstomia
Reduced oral opening
Vestibular obliteration
Ankyloglossie
Dental crowding
Halitosis
épiderme
derme
EBDr
hypoderme
TREATMENT POSSIBILITIES:
EPIDERMOLYSIS BULLOSA DENTAL CARE
HOW ?
EPIDERMOLYSIS BULLOSA DENTAL CARE
HOW ?
ANAEROBES
AEROBES
SOCIO-ECONOMIC
DIFFICULTIES,
IMMIGRATION
YOUNG AGE
DISEASE
MICROSUBSTRAT
ORGANISMES
HOST
BAD FOOD HABITS
CARBOHYDRATES
FREQUENT
FOOD INTAKE
MIXED FOOD
LIQUID MEALS
+ SOLUTIONS
IMMUNO_
DEFICIENCY
REDUCED SALIVA FLOW,
XEROSTOMIA
SALIVARY CLEARANCE
PH
TOOTH
MORPHOLOGY
LACK OF SPACE,
DIFFICULT ORAL
HYGIENE
HARD-TISSUE
QUALITY
EXISTENT CARIES?
PSYCHOLOGICAL
AND MECHANICAL
STRESS
EPIDERMOLYSIS BULLOSA DENTAL CARE
HOW ?
RESPECT THE 4 TRADITIONNAL PILLARS!
- Alimentation
- Hygiène
- Fluor
- Regular visits for preventive measures
EPIDERMOLYSIS BULLOSA DENTAL CARE
CONCLUSION
-
EPIDERMOLYSIS BULLOSA DENTAL CARE
MERCI
EPIDERMOLYSIS BULLOSA DENTAL CARE
BIBLIOGRAPHY
BIBLIOGRAPHIE
- American Academy of Pediatric Dentistry, Guidelines on Infant Oral Health Care, American Academy of Pediatric Dentistry Reference Manual
2008-9, Chicago, 2009, pp 90-92
- Wells M, Oral health status of children with craniofacial anomalies. Pediatr Dent. 2013 May-Jun;35(3):E79-86.
- Picard A et Al. Calendrier et protocole interventionnel des fentes labiopalatines au sein du Service de chirurgie maxillo-faciale et plastique le l’Hôpital
D’Enfants Trousseau (AP-HP, Paris), Rev Orthop Dento Faciale 2011;45:291-299
- Crawford EG, Burkes EJ Briggaman RA: Hereditary epidermolysis bullosa: oral manifestations and dental therapy, O Surg. O Med. O Pathol, 42,
490-500 (1976)
-
Wright JT: Oral Manifestations of Epidermolysis Bulosa in EG Clinical Epidemiologiec, and Laboratrory Advances and the Findings of the National
EB Registry 236-256, The John Hopkins Universidty Press Baltimore (1999°
- Skogedal N, Saltnes S, Storhaug K: Recessive Dystrophic epidermolyis bullosa (RDEB) Caries preventio nand preventive extractions of molars.
Clinical presentation of 3 cases, 2008, Ref Type Conference Proceeding
- Kverneland B: Pourquoi a-t-on mal aux dents?, CLUD 2012
- Kverneland B et al: Les épidermolyses bulleuses de l’enfant, Revue francophone d’odontologie pédiatrique 2011 Vol06N4,pp161-70
- Huckert M et al: Epidermolyses bulleuses dystrophique, particularités de la prise en charge sous anesthesie generale, Revue francophone d’odontologie
pédiatrique 2011 Vol06N4,pp170-5
EPIDERMOLYSIS BULLOSA DENTAL CARE
LES EPIDERMOLYSES BULLEUSES HEREDITAIRES
LES ATTEINTES BUCCALES
Manifestations Directes de la
génodermatose (EB)
1: Bulles orales
2: Microstomie labiale
3: Ouverture buccale réduite
4: Synéchies vestibulaires
5: Ankyloglossie
6: Récessions gingivales
7: Volume global oral réduit
8: Hyposialie, xérostomie
9: Agueusie
10: Amélogénèse défectueuse
- Solutions ? - Attente thérapie
spécifique.
Manifestations Infectieuses et
Multifactorielles (indirectes)
de la maladie
1: Hygiène difficile
2: Stomatite
3: Glossite
4: Parodontopathies
5: Halitose
6: DDM – encombrement, malpositions
7: Caries
8: Pertes dentaires
9: Alimentation per os difficile
10: Gastrostomiae
- Solutions ?
LES EPIDERMOLYSES BULLEUSES HEREDITAIRES
L’HYGIENE BUCCO-DENTAIRE
90
MM, 2 ans,
score: 6 + 6
=12/100
score spécifiq
u e
80
score nonuspécifiqe
SOMME DES SCORES
70
Age d'examen (an)
60
NN, 9 ans,
score: 28 + 42
= 70/100
50
40
30
OO, 12 ans
score: 31 + 50
= 81/100
20
10
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